Publications
Identifying Distinct Risk Profiles to Predict Adverse Events Among Community-Dwelling Older Adults
by Melissa O'Connor, Alexandrea Hanlon, Elizabeth Mauer, et al.; November 1, 2017
This secondary analysis of data from HQP's Medicare Coordinated Care Demonstration uses Latent Class Analysis to provide a new way to cluster variables associated with a differential risk of adverse events (High, Medium, and Low Risk). Read more
by Melissa O'Connor, Alexandrea Hanlon, Elizabeth Mauer, et al.; November 1, 2017
This secondary analysis of data from HQP's Medicare Coordinated Care Demonstration uses Latent Class Analysis to provide a new way to cluster variables associated with a differential risk of adverse events (High, Medium, and Low Risk). Read more
Replicating Effective Models Of Complex Care Management For Older Adults
by Ken Coburn, Charlotte Grinberg, Sophia Demuynck, Margaret Hawthorne; June 7, 2017
This Health Affairs Blog post makes the case for investing in the R&D required to discover new and better means to replicate and spread effective models of complex care rather than limiting health transformation efforts to models perceived to be easier to scale, but typically less effective. Read more
by Ken Coburn, Charlotte Grinberg, Sophia Demuynck, Margaret Hawthorne; June 7, 2017
This Health Affairs Blog post makes the case for investing in the R&D required to discover new and better means to replicate and spread effective models of complex care rather than limiting health transformation efforts to models perceived to be easier to scale, but typically less effective. Read more
"In Our Corner": A Qualitative Descriptive Study of Patient Engagement in a Community-Based Care Coordination Program
by Justine Sefcik, Darina Petrovsky, Magen Streur, et. al. ; Dec. 2016
This study explores participants' experience in the HQP program and how those experiences relate to long-standing engagement. Focus groups were conducted. Key themes participants developed included; feeling like someone was "in our corner", "opportunities to learn and socialize" and "dedicated nurses." Read more
by Justine Sefcik, Darina Petrovsky, Magen Streur, et. al. ; Dec. 2016
This study explores participants' experience in the HQP program and how those experiences relate to long-standing engagement. Focus groups were conducted. Key themes participants developed included; feeling like someone was "in our corner", "opportunities to learn and socialize" and "dedicated nurses." Read more
Search for a practical strategy to disseminate models of advanced preventive care that improve the health of chronically ill older adults
by Ken Coburn; 2016
Developing new, more effective models of preventive care for an aging, chronically ill population is an important public health imperative. New models that provide more frequent and ongoing monitoring and assessments coupled with personalized preventive interventions are emerging. Such models of “advanced preventive care” are operationally demanding and costly to implement. Even when they improve health outcomes and reduce net health care expenditures, there are several barriers to the spread of such models and no guarantee they will come into widespread use. Little research has been undertaken to assess the role that innovators of new care models might play in facilitating their dissemination. The theoretical framework of Greenhalgh et al. helps conceptualize the position innovators hold relative to other entities involved in dissemination, but leaves unanswered the question of what direct actions innovators might take to facilitate dissemination (2008). Read more
by Ken Coburn; 2016
Developing new, more effective models of preventive care for an aging, chronically ill population is an important public health imperative. New models that provide more frequent and ongoing monitoring and assessments coupled with personalized preventive interventions are emerging. Such models of “advanced preventive care” are operationally demanding and costly to implement. Even when they improve health outcomes and reduce net health care expenditures, there are several barriers to the spread of such models and no guarantee they will come into widespread use. Little research has been undertaken to assess the role that innovators of new care models might play in facilitating their dissemination. The theoretical framework of Greenhalgh et al. helps conceptualize the position innovators hold relative to other entities involved in dissemination, but leaves unanswered the question of what direct actions innovators might take to facilitate dissemination (2008). Read more
Managing Chronic Illness: Nursing Contact and Participant Enrollment in a Medicare Care Coordination Demonstration Program
by Mark Toles, Helene Moriarty, Ken Coburn, Sherry Marcantonio, et. al. ; Aug. 2015
Maintaining participant engagement is essential for longitudinal programs designed to prevent complications of chronic disease. Only 11% of participants voluntarily disenrolled from HQP's program during an average follow-up of 5 years. Having a higher proportion of nurse contacts be in-person (vs. telephonic) was associated with a lower likelihood of voluntary disenrollment (HR = 0.137, CI 95% [0.050, 0.376]). Conversely, more frequent changes in participant nurse assignment (less continuity of care) was associated with an increased likelihood of voluntary disenrollment (HR = 1.964, CI 95% [1.724, 2.238]. Read more
by Mark Toles, Helene Moriarty, Ken Coburn, Sherry Marcantonio, et. al. ; Aug. 2015
Maintaining participant engagement is essential for longitudinal programs designed to prevent complications of chronic disease. Only 11% of participants voluntarily disenrolled from HQP's program during an average follow-up of 5 years. Having a higher proportion of nurse contacts be in-person (vs. telephonic) was associated with a lower likelihood of voluntary disenrollment (HR = 0.137, CI 95% [0.050, 0.376]). Conversely, more frequent changes in participant nurse assignment (less continuity of care) was associated with an increased likelihood of voluntary disenrollment (HR = 1.964, CI 95% [1.724, 2.238]. Read more
Managed Care
Programs for High-Need Patients: What Makes the Good Ones Good?
by Michael Levin-Epstein; Dec. 2014
This industry news piece summarizes the findings of the Commonwealth Fund Issue Brief (below) on effective models of care management and highlights HQP's program as a brief case study.
by Michael Levin-Epstein; Dec. 2014
This industry news piece summarizes the findings of the Commonwealth Fund Issue Brief (below) on effective models of care management and highlights HQP's program as a brief case study.
Commonwealth Fund: Issue Brief
Caring for High-Need, High-Cost Patients: What Makes for a Successful Care Management Program?
by C.S. Hong, A.L. Siegel, and T.G. Ferris; Aug. 7, 2014
This article provides a comprehensive overview of models that to date, have had the most success in managing complex, high-need populations. It is notable for being one of the only such reviews that ranks the level (strength) of evidence supporting the results each model has accrued to date. Of the 18 models reviewed, only 4 have the highest level of evidence - Level 1. HQP's advanced preventive care model is among this elite set of programs. Read more
by C.S. Hong, A.L. Siegel, and T.G. Ferris; Aug. 7, 2014
This article provides a comprehensive overview of models that to date, have had the most success in managing complex, high-need populations. It is notable for being one of the only such reviews that ranks the level (strength) of evidence supporting the results each model has accrued to date. Of the 18 models reviewed, only 4 have the highest level of evidence - Level 1. HQP's advanced preventive care model is among this elite set of programs. Read more
New England Journal of Medicine: Perspective
Toward Increased Adoption of Complex Care Management
by C.S. Hong, M.K. Abrams, and T.G. Ferris; Aug. 7, 2014
The authors, who participated in developing the Commonwealth Fund Issue Brief on successful complex care management models (above), reflect on the barriers hindering widespread adoption of effective complex care management models. In addressing the special challenge of implementing such programs in collaboration with smaller and/or highly decentralized primary care practices, the authors note, "... Government or private organizations can convene regional entities and create an organizational home for shared CCM [Complex Care Management] resources. Real-world examples include Vermont's Blueprint for Health and Health Quality Partners in Pennsylvania..." Read more
by C.S. Hong, M.K. Abrams, and T.G. Ferris; Aug. 7, 2014
The authors, who participated in developing the Commonwealth Fund Issue Brief on successful complex care management models (above), reflect on the barriers hindering widespread adoption of effective complex care management models. In addressing the special challenge of implementing such programs in collaboration with smaller and/or highly decentralized primary care practices, the authors note, "... Government or private organizations can convene regional entities and create an organizational home for shared CCM [Complex Care Management] resources. Real-world examples include Vermont's Blueprint for Health and Health Quality Partners in Pennsylvania..." Read more
Washington Post
If this were a pill, you'd do anything to get it
by Ezra Klein; April 28, 2013
After spending 2 days at HQP going out on home visits with nurses, observing our group programs, and conversing with our team, Ezra Klein nicely captured the key attributes and principles of HQP's program in this Washington Post article. Most importantly, he captured the place our program has in the lives of those we serve and the potential that continued R&D in this field holds for improving the health of our nation. Read more
by Ezra Klein; April 28, 2013
After spending 2 days at HQP going out on home visits with nurses, observing our group programs, and conversing with our team, Ezra Klein nicely captured the key attributes and principles of HQP's program in this Washington Post article. Most importantly, he captured the place our program has in the lives of those we serve and the potential that continued R&D in this field holds for improving the health of our nation. Read more
PLoS Medicine
Effect of a Community-Based Nursing Intervention on Mortality in Chronically Ill Older Adults: A Randomized Controlled Trial
by K.D. Coburn, S. Marcantonio, R. Lazansky, M. Keller, N. Davis
July 17, 2012
Compared to those receiving usual care, the HQP community-based care management model reduced deaths by 25% among chronically ill older adults. And unlike many medical interventions, this result was achieved with no known adverse effects through advanced preventive care using a longitudinal nursing intervention provided in collaboration with primary care physicians and other key assets of the health system. This is the most rigorously conducted (randomized, controlled trial, analyzed on an intention to treat basis), long-term (average follow up 4.2 years) study of a community-based intervention of this kind. It provides an important proof of concept that highly effective prevention programs, if carefully designed and rigorously implemented, offer a means to address many challenges our health system now faces. This study was undertaken as part of HQP's participation in the Medicare Coordinated Care Demonstration run by the Centers for Medicare & Medicaid Services (CMS) in the U.S. This federally sponsored research is yielding important insights into how providing highly-effective preventive services that improve health outcomes can also save money. Read more
by K.D. Coburn, S. Marcantonio, R. Lazansky, M. Keller, N. Davis
July 17, 2012
Compared to those receiving usual care, the HQP community-based care management model reduced deaths by 25% among chronically ill older adults. And unlike many medical interventions, this result was achieved with no known adverse effects through advanced preventive care using a longitudinal nursing intervention provided in collaboration with primary care physicians and other key assets of the health system. This is the most rigorously conducted (randomized, controlled trial, analyzed on an intention to treat basis), long-term (average follow up 4.2 years) study of a community-based intervention of this kind. It provides an important proof of concept that highly effective prevention programs, if carefully designed and rigorously implemented, offer a means to address many challenges our health system now faces. This study was undertaken as part of HQP's participation in the Medicare Coordinated Care Demonstration run by the Centers for Medicare & Medicaid Services (CMS) in the U.S. This federally sponsored research is yielding important insights into how providing highly-effective preventive services that improve health outcomes can also save money. Read more
Health Affairs
Six Features of Medicare Coordinated Care Demonstration Programs That Cut Hospital Admissions of High-Risk Patients
by Randall S. Brown, et al.; June 2012
In this article, researchers from Mathematica Policy Research, Inc. that undertook the evaluation of the MCCD for CMS consider attributes shared by the most successful of the MCCD programs - looking for common elements that are essential for effective care management. HQP's program of nurse care management was reported to reduce hospitalizations 33% and lower Medicare expenditures 22% among higher-risk, chronically ill Medicare beneficiaries. The findings are consistent with earlier reports on the impact of HQP's program on higher-risk chronically ill Medicare beneficiaries. The higher-risk subgroup analyzed in the Health Affairs study was slightly different than the one analyzed in the Fourth Report to Congress on the Evaluation of the Medicare Coordinated Care Demonstration released in March 2011, for which participation in HQP's program was associated with 39% fewer hospitalizations and a net decrease in Medicare expenditures of 28%.
Among attributes the authors considered that may be necessary for successful models, they noted, "... the presence of strong, evidence-based patient education intervention. The education interventions in the programs at Health Quality Partners and Mercy Medical Center were among the top three when all fifteen programs were rated in the original evaluation.." And "...the demonstration program with the largest effects, at Health Quality Partners, was very data-driven, tracking care coordinators’ performance and continually assessing the effectiveness of newly introduced intervention components and refinements to existing ones..." Read more
by Randall S. Brown, et al.; June 2012
In this article, researchers from Mathematica Policy Research, Inc. that undertook the evaluation of the MCCD for CMS consider attributes shared by the most successful of the MCCD programs - looking for common elements that are essential for effective care management. HQP's program of nurse care management was reported to reduce hospitalizations 33% and lower Medicare expenditures 22% among higher-risk, chronically ill Medicare beneficiaries. The findings are consistent with earlier reports on the impact of HQP's program on higher-risk chronically ill Medicare beneficiaries. The higher-risk subgroup analyzed in the Health Affairs study was slightly different than the one analyzed in the Fourth Report to Congress on the Evaluation of the Medicare Coordinated Care Demonstration released in March 2011, for which participation in HQP's program was associated with 39% fewer hospitalizations and a net decrease in Medicare expenditures of 28%.
Among attributes the authors considered that may be necessary for successful models, they noted, "... the presence of strong, evidence-based patient education intervention. The education interventions in the programs at Health Quality Partners and Mercy Medical Center were among the top three when all fifteen programs were rated in the original evaluation.." And "...the demonstration program with the largest effects, at Health Quality Partners, was very data-driven, tracking care coordinators’ performance and continually assessing the effectiveness of newly introduced intervention components and refinements to existing ones..." Read more
Philadelphia Inquirer
Fit to Be Tried; By keeping the sickest elderly people healthier, at reduced cost, a small Doylestown nonprofit is giving pointers to Medicare
by Josh Goldstein; March 2, 2009
Based on direct observation of nurse home visits and group programs, and interviews with staff and experts in this field, this article nicely captured the approach and impact the HQP program has on participants and its potential role in health system delivery reform. Read more
by Josh Goldstein; March 2, 2009
Based on direct observation of nurse home visits and group programs, and interviews with staff and experts in this field, this article nicely captured the approach and impact the HQP program has on participants and its potential role in health system delivery reform. Read more
JAMA
Effects of Care Coordination on Hospitalization, Quality of Care, and Health Care Expenditures Among Medicare Beneficiaries: 15 Randomized Trials
by D. Peikes, A. Chen, J. Schore, R. Brown; February 11, 2009
Overall results for the diverse set of programs in the MCCD suggested that many programs increased, rather than decreased, health care costs. "... Despite these underwhelming results for care coordination interventions in general, the favorable findings for Mercy and HQP suggest that the potential exists for care coordination interventions to be cost-neutral and to improve patients' well-being. Health Quality Partners' low fee was nearly fully offset by the treatment group's lower regular Medicare expenditures, and based on the subgroup analyses these savings would have been substantially larger had the program targeted only the highest severity group." [Note: in the initial phase of MCCD, HQP enrolled low, medium, and high risk individuals into its program]. Among the high severity subgroup the authors referenced, (representing about 30% of HQP's enrolled participants), the researchers observed program-associated decreases in hospitalizations and cost "... -29% for hospitalizations and -20% for expenditures ... P=0.009 and P=.07, respectively ..." Access the study here (specific reference to HQP higher-risk group impacts are on pages 613-14).
by D. Peikes, A. Chen, J. Schore, R. Brown; February 11, 2009
Overall results for the diverse set of programs in the MCCD suggested that many programs increased, rather than decreased, health care costs. "... Despite these underwhelming results for care coordination interventions in general, the favorable findings for Mercy and HQP suggest that the potential exists for care coordination interventions to be cost-neutral and to improve patients' well-being. Health Quality Partners' low fee was nearly fully offset by the treatment group's lower regular Medicare expenditures, and based on the subgroup analyses these savings would have been substantially larger had the program targeted only the highest severity group." [Note: in the initial phase of MCCD, HQP enrolled low, medium, and high risk individuals into its program]. Among the high severity subgroup the authors referenced, (representing about 30% of HQP's enrolled participants), the researchers observed program-associated decreases in hospitalizations and cost "... -29% for hospitalizations and -20% for expenditures ... P=0.009 and P=.07, respectively ..." Access the study here (specific reference to HQP higher-risk group impacts are on pages 613-14).
Medicare Coordinated Care Demonstration (MCCD)
Third Report to Congress - In the Third Report to Congress on the Evaluation of the Medicare Coordinated Care Demonstration (June 3, 2008), which included a broad range of patients in low, moderate, and high risk categories, CMS determined HQP’s model is “clearly cost neutral,” “sustainable” and “promising.” The treatment group “had 14 percent fewer hospitalizations than the control group (p=0.12).” Medicare Part A and B expenditures among the treatment group were “14 percent lower than those of the control group, and the results were statistically significant (p=0.07)”. Regarding patient experience, “On several dimensions, Health Quality Partners received consistently higher ratings from their patients than the other programs.” Including “highest scoring on patient education and its high ranking on patient monitoring”. Access the full report here.
Fourth Report to Congress - HQP’s evaluation by CMS has been undertaken through a long-running, prospective, randomized controlled trial. The Fourth Report to Congress on the Evaluation of the Medicare Coordinated Care Demonstration, March 2011 by Jennifer Schore and colleagues at Mathematica Policy Research, Inc. included the following results: Among high-risk participants, HQP’s model of Advanced Preventive Care reduced deaths -30.4% (p=0.03), hospitalizations -38.8% (p<0.01), emergency room visits -37% (p=0.05), average monthly Part A and B Medicare expenditures -$511 (-35.5%, p=0.01), and average monthly net expenditures (including program fees) -$397 (-27.6%, p=0.05). Access the full report here.